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896 KiB

Open AccessArticle

How Hyperarousal and Sleep Reactivity Are Represented in Different Adult Age Groups: Results from a Large Cohort Study on Insomnia

by Ellemarije Altena, Ivy Y. Chen, Yannick Daviaux, Hans Ivers, Pierre Philip and Charles M. Morin

Brain Sci. 2017, 7(4), 41; https://doi.org/10.3390/brainsci7040041 - 14 Apr 2017

Cited by 19 | Viewed by 13526

Abstract

Hyperarousal is a 24-h state of elevated cognitive and physiological activation, and is a core feature of insomnia. The extent to which sleep quality is affected by stressful events—so-called sleep reactivity—is a vulnerability factor for developing insomnia. Given the increasing prevalence of insomnia [...] Read more.

Hyperarousal is a 24-h state of elevated cognitive and physiological activation, and is a core feature of insomnia. The extent to which sleep quality is affected by stressful events—so-called sleep reactivity—is a vulnerability factor for developing insomnia. Given the increasing prevalence of insomnia with age, we aimed to investigate how hyperarousal and sleep reactivity were related to insomnia severity in different adult age groups. Data were derived from a large cohort study investigating the natural history of insomnia in a population-based sample (n = 1693). Baseline data of the Arousal Predisposition Scale (APS) and Ford Insomnia Response to Stress Test (FIRST) were examined across age and sleep/insomnia subgroups: 25–35 (n = 448), 35–45 (n = 528), and 45–55 year olds (n = 717); good sleepers (n = 931), individuals with insomnia symptoms (n = 450), and individuals with an insomnia syndrome (n = 312). Results from factorial analyses of variance (ANOVA) showed that APS scores decreased with increasing age, but increased with more severe sleep problems. FIRST scores were not significantly different across age groups, but showed the same strong increase as a function of sleep problem severity. The findings indicate that though arousal predisposition and sleep reactivity increase with more severe sleep problems, only arousal decreases with age. How arousing events affect an individual during daytime thus decreases with age, but how this arousal disrupts sleep is equivalent across different adult age groups. The main implication of these findings is that treatment of insomnia could be adapted for different age groups and take into consideration vulnerability factors such as hyperarousal and stress reactivity. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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258 KiB

Open AccessArticle

Predictors of Nightly Subjective-Objective Sleep Discrepancy in Poor Sleepers over a Seven-Day Period

by Vanessa Herbert, Daniel Pratt, Richard Emsley and Simon D. Kyle

Brain Sci. 2017, 7(3), 29; https://doi.org/10.3390/brainsci7030029 - 09 Mar 2017

Cited by 33 | Viewed by 6423

Abstract

This study sought to examine predictors of subjective/objective sleep discrepancy in poor sleepers. Forty-two individuals with insomnia symptoms (mean age = 36.2 years, 81% female) were recruited to take part in a prospective study which combined seven days of actigraphy with daily assessment [...] Read more.

This study sought to examine predictors of subjective/objective sleep discrepancy in poor sleepers. Forty-two individuals with insomnia symptoms (mean age = 36.2 years, 81% female) were recruited to take part in a prospective study which combined seven days of actigraphy with daily assessment of sleep perceptions, self-reported arousal, sleep effort, and mood upon awakening. A high level of intra-individual variability in measures of sleep discrepancy was observed. Multilevel modelling revealed that higher levels of pre-sleep cognitive activity and lower mood upon awakening were significantly and independently predictive of the underestimation of total sleep time. Greater levels of sleep effort predicted overestimation of sleep onset latency. These results indicate that psychophysiological variables are related to subjective/objective sleep discrepancy and may be important therapeutic targets in the management of insomnia. Full article

(This article belongs to the Special Issue New Research in Insomnia)

798 KiB

Open AccessArticle

Insomnia and Personality—A Network Approach

by Kim Dekker, Tessa F. Blanken and Eus J. W. Van Someren

Brain Sci. 2017, 7(3), 28; https://doi.org/10.3390/brainsci7030028 - 02 Mar 2017

Cited by 37 | Viewed by 7584

Abstract

Studies on personality traits and insomnia have remained inconclusive about which traits show the most direct associations with insomnia severity. It has moreover hardly been explored how traits relate to specific characteristics of insomnia. We here used network analysis in a large sample [...] Read more.

Studies on personality traits and insomnia have remained inconclusive about which traits show the most direct associations with insomnia severity. It has moreover hardly been explored how traits relate to specific characteristics of insomnia. We here used network analysis in a large sample (N = 2089) to obtain an integrated view on the associations of personality traits with both overall insomnia severity and different insomnia characteristics, while distinguishing direct from indirect associations. We first estimated a network describing the associations among the five factor model personality traits and overall insomnia severity. Overall insomnia severity was associated with neuroticism, agreeableness, and openness. Subsequently, we estimated a separate network describing the associations among the personality traits and each of the seven individual items of the Insomnia Severity Index. This revealed relatively separate clusters of daytime and nocturnal insomnia complaints, that both contributed to dissatisfaction with sleep, and were both most directly associated with neuroticism and conscientiousness. The approach revealed the strongest direct associations between personality traits and the severity of different insomnia characteristics and overall insomnia severity. Differentiating them from indirect associations identified the targets for improving Cognitive Behavioral Therapy for insomnia with the highest probability of effectively changing the network of associated complaints. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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327 KiB

Open AccessArticle

Group vs. Individual Treatment for Acute Insomnia: A Pilot Study Evaluating a “One-Shot” Treatment Strategy

by Pam Boullin, Christina Ellwood and Jason G. Ellis

Brain Sci. 2017, 7(1), 1; https://doi.org/10.3390/brainsci7010001 - 23 Dec 2016

Cited by 27 | Viewed by 5821

Abstract

Background: Despite undeniable evidence for the efficacy and effectiveness of Cognitive Behaviour Therapy for Insomnia (CBT-I), the potential for its widespread dissemination and implementation has yet to be realised. A suggested reason for this is that traditional CBT-I is considered too burdensome for [...] Read more.

Background: Despite undeniable evidence for the efficacy and effectiveness of Cognitive Behaviour Therapy for Insomnia (CBT-I), the potential for its widespread dissemination and implementation has yet to be realised. A suggested reason for this is that traditional CBT-I is considered too burdensome for deployment, in its current form, within the context of where it would be most beneficial—Primary Care. One strategy, aimed to address this, has been to develop briefer versions of CBT-I, whilst another has been to deliver CBT-I in a group format. An alternative has been to attempt to address insomnia during its acute phase with a view to circumventing its progression to chronic insomnia. The aim of the present study was to compare a brief version of CBT-I (one-shot) when delivered individually or in groups to those with acute insomnia. Method: Twenty-eight individuals with acute insomnia (i.e., meeting full DSM-5 criteria for insomnia disorder for less than three months) self-assigned to either a group or individual treatment arm. Treatment consisted of a single one-hour session accompanied by a self-help pamphlet. Subjects completed measures of insomnia severity, anxiety and depression pre-treatment and at one-month post-treatment. Additionally, daily sleep diaries were compared between pre-treatment and at the one-month follow up. Results: There were no significant between group differences in treatment outcome on any sleep or mood measures although those in the group treatment arm were less adherent than those who received individual treatment. Furthermore, the combined (group and individual treatment arms) pre-post test effect size on insomnia symptoms, using the Insomnia Severity Index, was large (d = 2.27). Discussion: It appears that group treatment is as efficacious as individual treatment within the context of a “one shot” intervention for individuals with acute insomnia. The results are discussed with a view to integrating one-shot CBT-I in Primary Care. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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566 KiB

Open AccessArticle

Insomnia Phenotypes Based on Objective Sleep Duration in Adolescents: Depression Risk and Differential Behavioral Profiles

by Julio Fernandez-Mendoza, Susan L. Calhoun, Alexandros N. Vgontzas, Yun Li, Jordan Gaines, Duanping Liao and Edward O. Bixler

Brain Sci. 2016, 6(4), 59; https://doi.org/10.3390/brainsci6040059 - 13 Dec 2016

Cited by 32 | Viewed by 6203

Abstract

Based on previous studies on the role of objective sleep duration in predicting morbidity in individuals with insomnia, we examined the role of objective sleep duration in differentiating behavioral profiles in adolescents with insomnia symptoms. Adolescents from the Penn State Child Cohort ( [...] Read more.

Based on previous studies on the role of objective sleep duration in predicting morbidity in individuals with insomnia, we examined the role of objective sleep duration in differentiating behavioral profiles in adolescents with insomnia symptoms. Adolescents from the Penn State Child Cohort (n = 397, ages 12–23, 54.7% male) underwent a nine-hour polysomnography (PSG), clinical history, physical examination and psychometric testing, including the Child or Adult Behavior Checklist and Pediatric Behavior Scale. Insomnia symptoms were defined as a self-report of difficulty falling and/or staying asleep and objective “short” sleep duration as a PSG total sleep time ≤7 h. A significant interaction showed that objective short sleep duration modified the association of insomnia symptoms with internalizing problems. Consistently, adolescents with insomnia symptoms and short sleep duration were characterized by depression, rumination, mood dysregulation and social isolation, while adolescents with insomnia symptoms and normal sleep duration were characterized by rule-breaking and aggressive behaviors and, to a lesser extent, rumination. These findings indicate that objective sleep duration is useful in differentiating behavioral profiles among adolescents with insomnia symptoms. The insomnia with objective short sleep duration phenotype is associated with an increased risk of depression earlier in the lifespan than previously believed. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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Review

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436 KiB

Open AccessReview

Intensive Sleep Re-Training: From Bench to Bedside

by Leon Lack, Hannah Scott, Gorica Micic and Nicole Lovato

Brain Sci. 2017, 7(4), 33; https://doi.org/10.3390/brainsci7040033 - 27 Mar 2017

Cited by 12 | Viewed by 6460

Abstract

Intensive sleep re-training is a promising new therapy for chronic insomnia. Therapy is completed over a 24-h period during a state of sleep deprivation. Improvements of sleep and daytime impairments are comparable to the use of stimulus control therapy but with the advantage [...] Read more.

Intensive sleep re-training is a promising new therapy for chronic insomnia. Therapy is completed over a 24-h period during a state of sleep deprivation. Improvements of sleep and daytime impairments are comparable to the use of stimulus control therapy but with the advantage of a rapid reversal of the insomnia. The initial studies have been laboratory based and not readily accessible to the patient population. However, new smart phone technology, using a behavioral response to external stimuli as a measure of sleep/wake state instead of EEG determination of sleep, has made this new therapy readily available. Technological improvements are still being made allowing the therapy to provide further improvements in the effectiveness of Intensive Sleep Re-training. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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1292 KiB

Open AccessReview

Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies

by Daniel B. Kay and Daniel J. Buysse

Brain Sci. 2017, 7(3), 23; https://doi.org/10.3390/brainsci7030023 - 23 Feb 2017

Cited by 89 | Viewed by 11168

Abstract

Neuroimaging studies have produced seemingly contradictory findings in regards to the pathophysiology of insomnia. Although most study results are interpreted from the perspective of a “hyperarousal” model, the aggregate findings from neuroimaging studies suggest a more complex model is needed. We provide a [...] Read more.

Neuroimaging studies have produced seemingly contradictory findings in regards to the pathophysiology of insomnia. Although most study results are interpreted from the perspective of a “hyperarousal” model, the aggregate findings from neuroimaging studies suggest a more complex model is needed. We provide a review of the major findings from neuroimaging studies, then discuss them in relation to a heuristic model of sleep-wake states that involves three major factors: wake drive, sleep drive, and level of conscious awareness. We propose that insomnia involves dysregulation in these factors, resulting in subtle dysregulation of sleep-wake states throughout the 24 h light/dark cycle. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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250 KiB

Open AccessReview

Genetic Pathways to Insomnia

by Mackenzie J. Lind and Philip R. Gehrman

Brain Sci. 2016, 6(4), 64; https://doi.org/10.3390/brainsci6040064 - 20 Dec 2016

Cited by 43 | Viewed by 8237

Abstract

This review summarizes current research on the genetics of insomnia, as genetic contributions are thought to be important for insomnia etiology. We begin by providing an overview of genetic methods (both quantitative and measured gene), followed by a discussion of the insomnia genetics [...] Read more.

This review summarizes current research on the genetics of insomnia, as genetic contributions are thought to be important for insomnia etiology. We begin by providing an overview of genetic methods (both quantitative and measured gene), followed by a discussion of the insomnia genetics literature with regard to each of the following common methodologies: twin and family studies, candidate gene studies, and genome-wide association studies (GWAS). Next, we summarize the most recent gene identification efforts (primarily GWAS results) and propose several potential mechanisms through which identified genes may contribute to the disorder. Finally, we discuss new genetic approaches and how these may prove useful for insomnia, proposing an agenda for future insomnia genetics research. Full article

(This article belongs to the Special Issue New Research in Insomnia)

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